| NPI | 1861752560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY LETHIN Owner 907-337-9474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AK 1133) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK 1207) |
| 122300000X Dentist (Licence: AK 213) | |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2012-05-29 |